This application to join the NICHD Maternal Fetal Medicine Units Network is a combined proposal from the Oregon Health &Science University (OHSU) and Kaiser Permanente Oregon/Washington (KPNW) region. It is the result of a long-standing collaboration between OHSU and KPNW in maternal fetal medicine and brings together university and community research capabilities, which will increase diversity in enrollment. The combined deliveries (4091 in 2003 and 4043 in 2004) concentrate high risk patients in principally two sites: the Perinatal Center at Doernbecher Children's hospital at OHSU and the KPNW Perinatal Center at St. Vincent's Hospital. Both centers serve to selectively funnel consultations for genetics, preconception counseling, high resolution ultrasonography, high risk obstetrics and fetal echocardiography and are staffed by Maternal Fetal Medicine Specialists. Both OHSU and KPNW have a long history of conducting respected clinical research independently and together. This collaboration is based upon shared laboratory services and maternal fetal medicine coverage, an integrated residency in Obstetrics &Gynecology, and the combined strengths in research of the KPNW Center for Health Research and the Oregon Evidence-based Practice Center. The Center for Health Research (KPNW) and the Women's Health Research Unit (OHSU) have extensive experience in clinical trials and the research staff to facilitate the enrollment of patients in clinical studies. Focusing patient recruitment in two sites staffed by maternal fetal medicine specialists committed to this proposal will enhance enrollment and participation by research staff as well as maximize the quality of data obtained.